Journal Article > Study

This head-to-head comparison of two different medication reconciliation tools in electronic health records demonstrated that clinicians using one electronic platform made significantly fewer errors compared to clinicians using the other. The authors advocate for conducting this type of rigorous user testing to ensure electronic health record safety.

An accurate list of patient medications is a necessary precursor for safe medication use. One strategy to improve medication reconciliation is to provide a list of dispensed outpatient medications to inpatient clinicians upon hospital admission via an electronic medication reconciliation process. This retrospective chart review study compared a research pharmacist–generated gold standard medication list to the actual medications ordered during an admission after such a process was implemented. The study team identified medication discrepancies between the pharmacist-generated and admission-ordered medication lists and noted any inappropriately prescribed or continued medications. Medication errors were present in nearly half of the patient records; about 9% of errors were clinically important. The authors raise concerns that electronically prepopulated medication reconciliation forms may actually adversely impact medication safety. A previous WebM&M commentary discussed how to enhance accuracy of medication reconciliation.

Journal Article > Commentary

Despite the support for maintaining medication lists in electronic health records, these lists can contain and perpetuate errors. This commentary suggests that a set of standards are needed to ensure accuracy of electronic medication lists and reduce unnecessary or duplicate prescriptions in discharge instructions.

Cases & Commentaries

After leaving Hospital X against medical advice, a man with paraplegia presented to the emergency department of Hospital Y with pain and fever. The patient was diagnosed with sepsis and admitted to Hospital Y for management. In the night, the nurse found the patient unresponsive and called a code blue. The patient was resuscitated and transferred to the ICU, where physicians determined that the arrest was due to acute rupturing of his red blood cells (hemolysis), presumably caused by a reaction to the antibiotic. Later that day, the patient's records arrived from three hospitals where he had been treated recently. One record noted that he had previously experienced a life-threatening allergic reaction to the antibiotic, which was new information for the providers at Hospital Y.

Journal Article > Study

Medication errors are likely the most common safety problem in primary care, and ensuring accurate medication reconciliation remains a challenge in the outpatient setting. This innovative cluster-randomized trial, conducted in a health system with integrated electronic medical records (EMRs), used a novel method of engaging patients in safety to attempt to reduce medication error risk. Patients in the intervention completed their own medication lists, which could then be viewed and reconciled within the EMR by their physicians. Patients who participated had a lower incidence of medication discrepancies and fewer potential adverse drug events than control patients. Although preliminary, the study results point toward further ways in which EMRs can enhance safety by improving patient–physician communication.

Journal Article > Study

Medication reconciliation was initially established as a National Patient Safety Goal (NPSG) in 2005. However, difficulty establishing and implementing effective medication reconciliation approaches led to The Joint Commission suspending evaluation of this NPSG in 2009 and eventually eliminating it as a separate NPSG in 2011. This report from a large health care system provides a detailed template for integrating medication reconciliation into clinician workflow in the outpatient setting. Through a combination of leadership engagement, rapid cycle quality improvement projects, and financial incentives, the organization achieved consistent and sustained improvement in documentation of medication reconciliation for pediatric patients over a 5-year period. As medication reconciliation has been less studied in the ambulatory care setting, this study provides a useful window into the barriers inherent in changing outpatient clinician workflow and the steps this organization took to minimize unintended consequences of the intervention.

Journal Article > Study

Achieving medication reconciliation continues to present significant challenges, despite existing guidelines and its demonstrated impact on patient safety. Electronic health records (EHRs) and related tools have long been touted as solutions to bolster reconciliation safety. This study evaluated whether an EHR shared between outpatient and inpatient providers could reduce suspected medication discrepancies. Although errors were reduced, significant discrepancies persisted among various forms of reconciliation, including differences between what was in the record and what patients actually reported taking. Problems included outdated or incomplete medication information, incorrect information provided by patients, or mismatched information between the different sources. The authors argue that EHRs, as an added information vehicle, may help reduce reconciliation errors, but they caution that EHRs are only a tool (and not in themselves a solution) for safer reconciliation. A past AHRQ WebM&M commentary discussed whose job it is to assure safe medication reconciliation.

Efforts to prevent medication-related adverse events after hospital discharge have largely focused on medication reconciliation at the time of discharge. This study reports on the early experience with a medication reconciliation tool for use by primary care physicians after discharge. Although initial uptake was low, the study reports on many lessons learned through initial implementation.

Journal Article > Study

This study applied a collaborative filtering approach as a tool to potentially predict drugs missing in a patient's observed medication list. This process may yield an additional strategy to provide safe medication reconciliation.

Journal Article > Study

The accuracy of medication profiles at a small hospital was superior to that documented in other studies, a finding which the authors attribute to use of an integrated medication reconciliation system within the electronic medical record.

Journal Article > Study

Addressing handoffs in patient care is a continued challenge, particularly around medication safety. Medication reconciliation was seen as a preventive strategy to handle such concerns, though the lack of proven strategies led The Joint Commission to soften its previous National Patient Safety Goal. A commonly held belief is that electronic health records (EHRs) provide solutions to communicating health information. This study compared medication reconciliation events for patient handoffs within a computerized VA system to a paper-based system outside the VA. Interestingly, there was no significant difference between medication discrepancies and adverse drug events (ADEs) in the highly computerized system. The authors suggest that their findings support a need for specialized tools to facilitate medication review at times of transfer. A past AHRQ WebM&M commentary discussed medication reconciliation after an avoidable error.

Journal Article > Study

In this study conducted in a community pharmacy, medication reconciliation identified an average of 6 medication discrepancies per patient, mostly pertaining to medications that had been discontinued but remained on the pharmacy list.

Journal Article > Review

This review examined the literature on postdischarge safety and discontinuities in care. The authors identify common types of postdischarge adverse events and provide constructive recommendations to improve safety after hospitalization.

In this study, patients had access to a web-based electronic health record that allowed them to view their medication list and report inaccuracies. However, medication lists were found to be equally inaccurate for users and nonusers of the system.

Pharmacists are expanding their reach as stewards of medication safety into the front line of care. This project report describes the pilot testing of pharmacist involvement in development and review of medication orders in the discharge workflow. A substantive percentage of medication problems were prevented due to pharmacist engagement.